Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
Motion Analysis Laboratory, Mayo Clinic, DAHLC 4-214A, 200 First Street SW, Rochester, MN, 55905, USA.
J Neuroeng Rehabil. 2023 Nov 9;20(1):151. doi: 10.1186/s12984-023-01277-7.
Peripheral nerve injuries and central neurologic conditions can result in extensive disabilities. In cases with unilateral impairment, assessing the asymmetry between the upper extremity has been used to assess outcomes of treatment and severity of injury. A wide variety of validated and novel tests and sensors have been utilized to determine the upper extremity asymmetry. The purpose of this article is to review the literature and define the current state of the art for describing upper extremity asymmetry in patients with peripheral nerve injuries or central neurologic conditions.
An electronic literature search of PubMed, Scopus, Web of Science, OVID was performed for publications between 2000 to 2022. Eligibility criteria were subjects with neurological conditions/injuries who were analyzed for dissimilarities in use between the upper extremities. Data related to study population, target condition/injury, types of tests performed, sensors used, real-world data collection, outcome measures of interest, and results of the study were extracted. Sackett's Level of Evidence was used to judge the quality of the articles.
Of the 7281 unique articles, 112 articles met the inclusion criteria for the review. Eight target conditions/injuries were identified (Brachial Plexus Injury, Cerebral Palsy, Multiple Sclerosis, Parkinson's Disease, Peripheral Nerve Injury, Spinal Cord Injury, Schizophrenia, and stroke). The tests performed were classified into thirteen categories based on the nature of the test and data collected. The general results related to upper extremity asymmetry were listed for all the reviewed articles. Stroke was the most studied condition, followed by cerebral palsy, with kinematics and strength measurement tests being the most frequently used tests. Studies with a level of evidence level II and III increased between 2000 and 2021. The use of real-world evidence-based data, and objective data collection tests also increased in the same period.
Adequately powered randomized controlled trials should be used to study upper extremity asymmetry. Neurological conditions other than stroke should be studied further. Upper extremity asymmetry should be measured using objective outcome measures like motion tracking and activity monitoring in the patient's daily living environment.
周围神经损伤和中枢神经系统疾病可导致广泛的残疾。在单侧损伤的情况下，评估上肢的不对称性已被用于评估治疗效果和损伤严重程度。已经使用了各种经过验证和新颖的测试和传感器来确定上肢的不对称性。本文的目的是回顾文献，定义目前用于描述周围神经损伤或中枢神经系统疾病患者上肢不对称的最新技术状态。
对 PubMed、Scopus、Web of Science、OVID 进行电子文献检索，检索 2000 年至 2022 年期间的出版物。入选标准为分析上肢使用差异的神经状况/损伤患者。提取与研究人群、目标状况/损伤、进行的测试类型、使用的传感器、真实世界数据采集、感兴趣的结果测量和研究结果相关的数据。使用 Sackett 证据水平来判断文章的质量。
在 7281 篇独特的文章中，有 112 篇文章符合综述的纳入标准。确定了 8 种目标状况/损伤（臂丛神经损伤、脑瘫、多发性硬化症、帕金森病、周围神经损伤、脊髓损伤、精神分裂症和中风）。根据测试的性质和收集的数据，将进行的测试分为 13 类。列出了所有综述文章中与上肢不对称性相关的一般结果。中风是研究最多的疾病，其次是脑瘫，最常用的测试是运动学和力量测量测试。2000 年至 2021 年期间，具有 II 级和 III 级证据水平的研究增加。同期也增加了基于真实世界证据的研究和客观数据采集测试的使用。
应该使用充分有力的随机对照试验来研究上肢不对称性。除中风外，还应进一步研究其他神经状况。应使用客观的结果测量方法，如运动跟踪和活动监测，在患者的日常生活环境中测量上肢不对称性。
